Clinical Mental Health Counseling Program...Clinical Mental Health Counseling Faculty (Full-time)...

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Clinical Mental Health Counseling Program Clinical Experience Handbook 2019-2020 A Guide to: GCOU 650 Supervised Practicum GCOU 651 Supervised Internship A Handbook for Students, Faculty, and Supervisors Clinical Mental Health Counseling Program Psychology and Counseling Department A.J. Palumbo Academic Center, Rm. 2219 Gannon University 109 University Square Erie, PA 16541-0001 (814) 871-7538 / (814) 871-5511 Fax http://www.gannon.edu/cmhc Revised July 2019

Transcript of Clinical Mental Health Counseling Program...Clinical Mental Health Counseling Faculty (Full-time)...

Page 1: Clinical Mental Health Counseling Program...Clinical Mental Health Counseling Faculty (Full-time) Timothy Coppock, Ph.D., LPC, PCC-S (Ohio), NCC Associate Professor of Clinical Mental

Clinical Mental Health

Counseling Program

Clinical Experience Handbook

2019-2020

A Guide to:

GCOU 650 Supervised Practicum

GCOU 651 Supervised Internship

A Handbook for Students, Faculty, and Supervisors

Clinical Mental Health Counseling Program

Psychology and Counseling Department

A.J. Palumbo Academic Center, Rm. 2219

Gannon University

109 University Square

Erie, PA 16541-0001

(814) 871-7538 / (814) 871-5511 Fax

http://www.gannon.edu/cmhc

Revised July 2019

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Table of Contents Clinical Mental Health Counseling Program Mission Statement ............................................3

Purpose of Clinical Experience & Overview ..............................................................................4

Pre-Practicum Work Experience……………………………………………………....5

Background Checks ..........................................................................................................5

Professional Liability Insurance ......................................................................................5

Guidelines for Video/Audio Recording and Record Keeping .......................................5

Expectations for Ethical and Professional Behavior .....................................................6

Practicum/Internship Student Retention Policy ........................................................................6

Practicum Purpose and Objectives .............................................................................................8

Preparing for Practicum ..............................................................................................................9

Step-by-Step Process ........................................................................................................9

Practicum Requirements ................................................................................................11

Internship Purpose and Objectives ...........................................................................................12

Preparing for Internship ............................................................................................................13

Step-by-Step Process ......................................................................................................13

Internship Requirements ...............................................................................................14

Appendix A: Practicum Request Form ....................................................................................15

Appendix B: Practicum Contract ..............................................................................................16

Appendix D: Internship Contract .............................................................................................20

Appendix E: Supervisor Data Form .........................................................................................24

Appendix F: Practicum/Internship Completion Form ...........................................................25

Appendix G: Counseling Skills Scale (CSS) .............................................................................26

Appendix H: Counselor Skill & Personal Development Form (CSPD-RF) ..........................30

Appendix I: Supervisor Feedback Form ..................................................................................34

Appendix J: Client Video/Audio Consent Form ......................................................................36

Appendix K: CPCE and NCE Exam Letter .............................................................................37

Appendix L: Policy and Guidelines for Social Networking/Electronic Media………… …38

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The Clinical Experience Handbook

This Clinical Experience Handbook is designed to provide the information needed to complete

GCOU 650 Supervised Practicum and GCOU 651 Supervised Internship. It defines and reviews

the following: objectives, policies, procedures, and all of the forms required for Practicum and

Internship. Students and site supervisors will receive a contract that outlines rights and

responsibilities. Graduate counseling students enrolled in Practicum and Internship will be

referred to as “counselors-in-training”.

Comments about this handbook are encouraged. Please send your comments to Dr. Timothy

Coppock, Clinical Experience Coordinator. The Clinical Mental Health Counseling Faculty

reserves the right to change the terms of the handbook.

Clinical Mental Health Counseling Faculty (Full-time)

Timothy Coppock, Ph.D., LPC, PCC-S (Ohio), NCC

Associate Professor of Clinical Mental Health Counseling

Clinical Experience Coordinator

814-871-5793

[email protected]

Kenneth McCurdy, Ph.D., LPC, NCC, ACS

Associate Professor of Clinical Mental Health Counseling

CACREP Coordinator

814-871-7791

[email protected]

Rebecca Willow, Ed.D., LPC, NCC

Associate Professor of Clinical Mental Health Counseling

Program Director

814-871-7721

[email protected]

Clinical Mental Health Counseling Program Mission Statement

The mission of Gannon University’s Clinical Mental Health Counseling Program is to educate

and train students to become professional counselors who are committed to the wellness of

individuals, families, groups, and the greater community. The philosophy of the program

focuses on the development of the competencies required of professional counselors. The

program objectives are (a) enhancing students’ knowledge of counseling theory and concepts;

(b) providing skills and training requisite of generalist entry-level counseling practitioners; c)

developing multicultural competencies; (d) promoting the development of sound legal and

ethical decision-making skills; and (e) preparing individuals for national certification and

professional licensure. Although students typically are drawn from the regional area, applicants

with diverse backgrounds and from outside the region are encouraged to apply. Students are

guided to embody and contribute to the spirit of diversity to which the program and profession

are committed.

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Purpose of the Clinical Experience

The purpose of the clinical experience is to provide Clinical Mental Health Counseling students

with structured and supervised counseling opportunities in order to develop effective counseling

skills and competencies. The Clinical Mental Health Counseling Program is accredited by the

Council for Accreditation of Counseling and Related Educational Programs (CACREP). The

clinical experiences have been designed to comply with national certification standards set forth by

CACREP and the National Board for Certified Counselors (NBCC) as well as the standards for

licensure set forth by the Pennsylvania Board of Social Workers, Marriage and Family Therapists,

and Professional Counselors.

Supervision in Practicum & Internship

Practicum faculty supervisors will provide a minimum of 1.5 hours of group supervision

weekly. Faculty supervisors may also provide 1 hour of individual or triadic supervision in

order to further meet the developmental needs of Practicum students. Internship faculty

supervisors will conduct two-hour group supervision sessions weekly. Practicum and internship

supervision will focus on the development of the students’ counseling skills and counselor

identity. Client cases will be reviewed using audio recordings of counseling sessions or live

observation.

Site Supervisor

Site supervisors will provide a minimum of one hour individual or triadic clinical supervision

weekly that will focus on counselor-in-training development and client welfare. Additional

supervision will be scheduled when deemed necessary by the supervisor or requested by the

supervisee. Site supervisors are approved by the clinical experience coordinator and participate

in training and continuing education provided by Gannon faculty. Site supervisor credentials

need to include:

Licensed Professional Counselor (LPC) credential or other mental health practitioner

credential

at least a master’s degree in counseling or equivalent related degree;

at least two years counseling experience;

training or experience in counselor supervision;

familiarity with the practicum and internship expectations of the Clinical Mental Health

Counseling Program.

Faculty Consultation with Site Supervisors

Faculty supervisors will maintain consistent standards for consultation with clinical site

supervisors. Faculty will conduct one site visit in conjunction with the site supervisor and the

counselor-in-training. Ideally this will occur before mid-term. In addition, faculty will maintain

regular contact by phone or email, at least four times per term. In turn, site supervisors will be

encouraged to contact faculty when needed. Interface with site supervisors will also occur on

occasions when it is necessary for the faculty supervisor to review recordings on-site.

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Pre-practicum Work Experience

Pre-practicum work experience is recommended as an aspect of the graduate learning

experience. Students are expected to gain developmental professional experience working with

clients in a mental health, health care, or social service setting. This type of experiential

learning provides opportunities to integrate counselor knowledge, enhance helping skills, and

develop personal and professional awareness. Furthermore, the practicum placement process

includes the endorsement of faculty and the site supervisor. Pre-practicum employment history

becomes “value-added” when students seek to secure the approval of supervisors for selected

sites. Ultimately, the wealth of professional experience contributes to career development and

future employment.

In accordance with the program’s student review and retention policy, the program director and

faculty advisor may enforce a directive for pre-practicum employment. The recommended

standard is 100 hours of entry level employment or volunteer service in an appropriate mental

health, social service, or health care setting.

Background Checks

Clearances needed are (as per Pennsylvania Act 33 and Act 34): Pennsylvania Child Abuse

History, Pennsylvania State Police Criminal Record Check, and FBI Fingerprint Check. These

are due in June during the Seminar course in preparation for the practicum and internship the

following Fall and Spring semesters. PLEASE NOTE: These are in addition to the clearances

submitted for admission to the Clinical Mental Health Counseling Program. Students will not be

cleared to begin practicum unless the clearances are submitted by the due date with the clinical

experience coordinator.

Professional Liability Insurance

Students are required to purchase and maintain professional liability insurance throughout

their supervised clinical experience. Faculty strongly recommend student membership in the

American Counseling Association (http://www.counseling.org ) which offers complimentary

student professional liability insurance. Counselors-in-training are required to submit proof of

liability insurance in June during the Seminar course in preparation for the practicum and

internship the following Fall and Spring semesters.

Guidelines for Recording and Record Keeping

Practicum and internship students will record at least two counseling sessions which will then

be reviewed during Supervised Practicum group class or at the clinical site with the faculty

supervisor. Recording devices are available to borrow from the department office. Cell phones

and computers are not acceptable recording devices. When not in use, it is the student’s

responsibility to keep the recording in a secure and confidential location. At the end of each

semester, the student is responsible for erasing/deleting all recordings. In some instances where

audio recording is not permitted, live observation by either the Site Supervisor or Faculty

Supervisor may be implemented with prior approval. Where clinical site policies differ, they

should be discussed with both faculty and site supervisors.

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Expectations for Ethical and Professional Behavior

Counselors-in-training are expected to be familiar with and follow the procedures of GCOU 650

Supervised Practicum and GCOU 651 Supervised Internship, as well as the clinical site rules

and regulations. Counselors-in-training have a responsibility to understand and follow the ACA

Code of Ethics and adhere to applicable laws, regulatory policies, and rules and policies

governing professional staff behavior at the agency or placement setting. It is the responsibility

of the counselor-in-training to develop professional habits of responsibility, accountability,

personal appearance, social media presentation, and self-management. It is the responsibility of

site and faculty supervisors to assist with these aspects of professional identity. All students are

required to follow the Social Networking Policy (Appendix N, p. 41) and abide by the social

media policy of their agency or placement.

The practicum experience requires dedication, willingness to attempt new techniques,

willingness to accept and work to integrate feedback and to experience the responsibilities of

professional counseling. Counselors-in-training are expected to seek out supervision with

faculty and site-supervisors in order to benefit the counselor/client therapeutic relationship. As

articulated in the 2014 ACA Code of Ethics, students are expected to demonstrate a willingness

and openness to work in an affirming way with all clients, regardless of clinical issues, client

identity, or value differences.

Counselors-in-training should refrain from offering or providing counseling services when their

physical, mental, or emotional problems are likely to harm a client or others (F.8 Student

Responsibilities). Students whose performance is likely to be impeded due to unmet

competencies may be required to remediate and demonstrate competency prior to advancement

in the program.

Student Retention in Practicum & Internship

Counselors-in-training are required to review the Retention and Student Review Policy in the

Clinical Mental Health Counseling Program Student Handbook.

Prior to practicum, all students will be reviewed by the Clinical Mental Health Counseling

program faculty. Students are expected to behave in a responsible and professional manner

while functioning in practicum and internship. Failure to conform one’s behavior to acceptable

standards of practice shall be considered cause for dismissal from practicum/internship or the

program. Cause for dismissal from either Practicum or Internship shall consist of, but not be

limited to:

1. Any activity that is prohibited under the ethical standards and practices of the American

Counseling Association (ACA). Students should obtain these standards and practices and

thoroughly read them.

2. Malicious disrespect toward instructors, supervisors, or fellow students; failure to follow

reasonable instructions; use of profanity or verbal or physical intimidation toward

instructors, supervisors, or fellow students.

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3. The use of fraud or deceit to obtain admission to the department, a course, a practicum

or an internship.

4. Soliciting or accepting a personal fee, monetary gift, or other form of remuneration or

compensation for counseling or other services while functioning as a practicum or

internship student.

5. Use of alcohol or other drugs to the extent that it impairs the student’s ability to perform

properly or adequately, or which may pose a threat to the welfare or safety of potential

or actual clients.

6. Conviction of an offense involving the sale, possession, or consumption of a controlled

substance.

7. Conviction of an offense that is a felony.

8. Conviction of an offense involving moral turpitude.

9. Conviction for a misdemeanor offense committed during the practice of any counseling

activity.

10. Any behavior, activity, procedure, or practice that is prohibited under the Counselor

Licensure laws of the Commonwealth of Pennsylvania.

The counseling profession demands the highest level of individual integrity as well as

demonstration of professional expertise in developing knowledge and skills appropriate to

effective counseling. Program faculty regularly review students’ academic performance as well

as monitor students’ professional behavior. Students who do not demonstrate the qualities and

skills associated with effective counseling may be advised to delay or to withdraw from

enrollment in practicum or internship. Students may be advised to complete a remediation plan

to address specific deficiencies. Students advised to withdraw from the program shall be offered

assistance in identifying an area of study or specialization that is more suited or appropriate to

their talents and skills.

Due process: Students who wish to appeal remediation decisions made by the department are

encouraged to follow the guidelines outlined in the most recent edition of The Gannon

University Graduate Catalog and the Gannon University Student Handbook.

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CLINICAL MENTAL HEALTH COUNSELING

GCOU 650 SUPERVISED PRACTICUM

Purpose and objectives of Practicum

The practicum clinical experience provides the counselor-in-training with the opportunity to

engage in the practice of counseling under the supervision of Clinical Mental Health Counseling

Program faculty and clinical site supervisors. Clinical Mental Health Counseling students will

complete their practicum experience at a clinical mental health agency or similar institution that

provides mental health counseling. The main objective of practicum is to provide graduate

counselors-in-training with closely supervised and highly structured clinical experiences to

facilitate professional development.

Counselor-in-training are expected to demonstrate the basic competencies of professional

counselors. One hundred (100) hours of direct counseling and related professional activities are

required. Counselors-in-training must complete a minimum of one and a half (1.5) hours of

course group supervision weekly. In addition, one hour (1) of individual or triadic supervision

with a site supervisor will be completed. At their discretion, faculty supervisors may also

provide individual or triadic supervision in order to further meet the developmental needs of

counselors-in-training. Supervision hours are not included in the 100 hour requirement for

practicum. Therefore, required practicum hours total approximately140, including:

(a) at least 40 direct hours,

(b) 60 indirect hours,

(c) course group supervision (about 20 hours)

(d) clinical site supervision (about 20 hours)

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Preparing For Practicum

Prerequisites for Fall Practicum: To be eligible to register for Practicum (GCOU 650),

students:

Must be in good standing in the program;

Are recommended to have prior experience working within a helping profession;

Must have completed or be concurrently enrolled in GCOU 690 Seminar in

Counseling;

Must have completed all of or be concurrently enrolled in the FOUNDATIONS,

CORE I, and CORE II courses.

Step-by-Step Procedures:

1. Attend Practicum / Internship Orientation prior to submitting application.

2. Practicum/Internship Request Form, Transcript, Program Matrix, and Clearances. All students eligible to enroll in practicum must complete a Practicum/Internship request

form. The form must be reviewed by the Faculty Advisor and submitted to the Clinical

Experience Coordinator by October 31 of the year prior to the planned practicum.

3. Consultation. The Clinical Experience Coordinator, faculty, and students who have

completed practicum may be able to provide insights about particular sites. Eligible

students will consult with their faculty advisor to collaboratively determine preferred

types of practicum experiences and a prioritized list of preferred sites. Criteria for site

selection will be based on student’s level of preparation, appropriateness for the site,

previous experience, career goals, and, ultimately, site availability. All clinical sites

must be within an 80-mile radius of Gannon University.

Faculty Advisors may not approve a practicum site if the potential exists for role

confusion. This could occur at sites where the student currently holds or previously held

a position within that organization (i.e., a caseworker desires a practicum as a mental

health therapist or resident director who desires a practicum at the university counseling

center).

4. Submit the Completed Practicum/Internship Request Form to the Clinical

Experience Coordinator

5. All Sites Must Be Approved by the Clinical Experience Coordinator PRIOR TO

CONTACT WITH THE SITE FOR AN INTERVIEW.

6. Contact site for interview. After permission has been granted by the Clinical

Experience Coordinator, it is recommended that students make contact to schedule an

appointment. It is recommended that students first place a phone call and follow up with

an email if necessary to schedule an interview with busy site supervisors. A face-to-face

interview for a practicum placement is required.

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7. Prepare for interview at selected site(s). Students should:

a. Prepare curriculum vitae (CV) and present to site interviewer.

b. Take the Clinical Experience Handbook to give to potential site supervisor.

c. Be prepared to present interests and goals along with the requirements set forth

by the Clinical Mental Health Counseling Program.

d. Make sure the site can meet all of the requirements of practicum.

e. Upon mutual consent, obtain dated signature of site supervisor on practicum

contract. This should be the signature of the person who will be the actual

supervisor if possible. (If this is not possible, the contract can be re-signed by the

actual supervisor at a later date.)

f. Students will be approved to interview only at one site at a time.

8. Submit contract to Clinical Experience Coordinator

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Practicum Requirements

The Practicum requires a counselor-in-training to complete 100 hours of supervised clinical

experience (excluding group, individual, and triadic supervision) that must:

{1} include a minimum total of 40 hours of direct service work with clients (extra

direct hours may be used as indirect hours) which may include: assessment,

individual counseling, other therapeutic interventions, consultation, family

counseling, group therapy, instructional interactions, and case conferences;

clients should represent the ethnic, lifestyle, and demographic diversity of the

larger community;

{2} include 60 hours of indirect counseling related activity not involving direct

service to clients which may include: contact with clients other than counseling,

staff meetings, report writing, case notes, case research, administrative duties,

resource exploration as directed by site supervisor;

{3} be under the supervision of an approved site supervisor; L.P.C. or related masters

level mental health provider who has at least two years of counseling experience;

{4} include a minimum of one hour per week of individual or triadic supervision by

an approved site supervisor; supervision hours do not count as direct or indirect

hours but must be recorded;

{5} include a minimum of 1.5 hours per week of group supervision provided by

program faculty supervisor; (additional individual hours may be required by

faculty supervisor as needed); supervision hours do not count as direct or

indirect hours but must be recorded;

{6} include access to information pertaining to interactions with clients for use in

individual and group supervision including but not limited to audio recordings or

live observation, information for case presentations, etc.;

{7} include supervised experience in the use of a variety of professional resources

such as appraisal instruments, software, print and non-print media, professional

literature, and research;

{8} include formal evaluations of the student’s performance by a site supervisor and

a program faculty supervisor in conjunction with both academic and licensure

purposes.

GCOU 650 Supervised Practicum must be completed before GCOU 651 Supervised

Internship.

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CLINICAL MENTAL HEALTH COUNSELING

GCOU 651 SUPERVISED INTERNSHIP

Purpose and objectives of Internship

The internship clinical experience provides the counselor-in-training with the opportunity to

engage in the practice of counseling under the supervision of Clinical Mental Health Counseling

Program faculty and clinical site supervisors. Clinical Mental Health Counseling students will

complete their internship experience at a clinical mental health agency or similar institution that

provides mental health counseling. The main objective of internship is to provide graduate

counseling students with closely supervised and highly structured clinical experiences to

facilitate advanced development as a professional counselor-in-training.

Counselor-in-training are expected to demonstrate the competencies of professional counselors.

Six hundred (600) hours of direct counseling and related professional activities are required.

Counselors-in-training must complete a minimum of two (2) hours of course group supervision

weekly. In addition, one hour (1) of individual or triadic supervision with a site supervisor will

be completed. At their discretion, faculty supervisors may also provide individual or triadic

supervision in order to further meet the developmental needs of counselors-in-training.

Supervision hours are included in the 600 hour requirement for internship including:

(a) at least 240 direct hours,

(b) 360 indirect hours,

(c) course group supervision (included in 360)

(d) clinical site supervision (included in 360)

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Preparing For Internship

Counselor-in-Training Responsibility for Internship

A 600 hour internship is a primary and full-time responsibility. The internship hours must be

conducted within the confined time schedule of the clinical site. When completing the

internship, students do not typically engage in substantial outside employment. If outside

employment is a necessity, students must discuss their circumstances with the Clinical

Experience Coordinator and assure that their employment does not interfere with the time

schedule, duties, and responsibilities of the supervised clinical experience. Full-time outside

employment is specifically not permitted.

Prerequisites for Internship:

To be eligible to register for Internship (GCOU 651), students:

Must be in good standing in the program;

Must have completed GCOU 650 Supervised Practicum, GCOU 690 Seminar in

Counseling, and GCOU 691 Counselor Preparation (Comps)*;

Must have completed all or concurrently enrolled in the FOUNDATIONS, CORE I,

and CORE II courses.

*Students remediating comprehensive examination content areas may enroll in Internship with

permission of the Program Director.

Step by step Internship process:

**In the atypical case when a student will be placed at an internship site different from their

practicum site, students should work closely with the Clinical Experience Coordinator for

specific instructions.

1. Submit internship contract to Clinical Experience Coordinator with final practicum

paperwork.

2. Arrange internship start date with site supervisor before finishing practicum.

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Internship Requirements

The Internship requires a counselor-in-training to complete 600 hours of supervised clinical

experience that must:

{1} not include clock hours from practicum (no clock hours may transfer from

practicum to internship)

{2} include a minimum total of 240 hours of direct service work with clients; clients

should represent the ethnic, lifestyle, and demographic diversity of the larger

community; extra direct hours may be used as indirect;

{2} include a 360 hours of indirect counseling related activity;

{3} be under the supervision of an approved site supervisor; LPC or master’s level

mental health provider who has at least two years of counseling experience;

{4} include a minimum of one hour per week of individual/triadic supervision by an

approved site supervisor;

{5} include a minimum of 1.5 hours per week of group supervision provided by a

program faculty supervisor;

{7} include a variety of other related professional activities other than direct

service work;

{8} include access to information pertaining to interactions with clients for use in

individual and group supervision including but not limited to audio recordings or

live observation, information for case presentations, etc.;

{9} allow Counselor-in-training to gain supervised experience in the use of a

variety of professional resources such as appraisal instruments, software, print

and non-print media, professional literature, and research;

{10} include formal evaluations of the student’s performance by a site supervisor and

a program faculty supervisor in conjunction with both academic and licensure

purposes.

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Gannon University

Clinical Mental Health Counseling Program

Practicum Request Form

Student’s Name: ____________________________________ Date: __________________

E-mail: _________________________ Cell Phone: _________________________

Practicum year _______________

Prospective Site(s)*: 1. ______________________________________________________

2. ______________________________________________________

3. ______________________________________________________

*Interviews should be scheduled only with permission from the Clinical Experience

Coordinator

I approve the student to apply for practicum:

____________________________________________ Date_____________

Signature of Advisor

To be completed by Clinical Experience Coordinator:

Date application received: ________________________________________

Sent interview approval for: ______________________________________/____________________________

Name of Practicum Site Secured: ________________________________________

Name of Primary Site Supervisor: ________________________________________

Contract in place: Background Clearances: Site Supervisor Data:

YES NO YESNO YESNO

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PRACTICUM - Clinical Experience Contract

Clinical Mental Health Counseling Program – Department of Psychology and Counseling

This contract between the MS-Clinical Mental Health Counseling Program in the Department of

Psychology and Counseling at Gannon University and

______________________________________ clarifies the joint and separate responsibilities of

each facility and for the practicum student during the ________semester 20___ for the

following student:____________________________________ and site supervisor:

_____________________________________________.

Practicum Site Responsibilities:

1. The practicum site is an equal opportunity employer.

2. The practicum site must provide a site supervisor who will provide one hour of individual or

triadic supervision per week. The supervisor’s credentials must include a minimum of a

master’s degree in counseling or a related field, and at least two years of professional

experience in the field.

3. It is expected that students will be exposed to a variety of activities on-site, including direct

client contact, supervision, consultation, staff meetings, in-service trainings, and assessment.

Clients’ presenting problems should be mental/emotional in nature to allow students to

develop and refine their counseling skills. At least 40 hours of the required 100 hours must

be in direct service. Student practicum will occur for the entire semester, averaging 8 hours

per week. Direct service includes individual, group, and family counseling, assessment and

intake services, psycho-educational services, and consultation provided to others.

4. Students are required to audio record or obtain live observation by the site supervisor or

faculty supervisor for at least two counseling sessions per semester, and the site will need to

allow for this provision. Recordings used for instructional purposes should have all

identifying information removed and be erased/deleted in their entirety following

supervisory sessions. Cell phones, tablets, or computers are not acceptable for recording.

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5. The site will provide sufficient office space, privacy for counseling sessions, use of

necessary equipment, office supplies, etc. for an effective practicum experience.

6. The site is responsible for informing the faculty supervisor of changes in agency policies,

procedures, and personnel that might affect the practicum experience.

7. Supervisees are required to work at the same location as their site supervisors or a

designated site supervisor, at all times. Supervisees are not allowed to conduct mobile

therapy, home visits, or transport clients. They should work within the regularly scheduled

hours that a designated site supervisor is on-site and readily accessible. Exceptions to this

policy require the expressed approval of the program Clinical Experience Coordinator.

8. The site agrees not to terminate the clinical experience placement prior to completion of the

university semester without a meeting between the student, the practicum coordinator, the

site supervisor, and other interested parties.

Site Supervisor Responsibilities:

1. The site supervisor will make every effort to provide opportunities for students to counsel

clients who represent the racial, ethnic, and demographic diversity of their community.

2. The site supervisor will be responsible for providing one hour of individual or triadic

supervision per week.

3. The site supervisor will allow for one site visit and four contacts with the Clinical Mental

Health Counseling Program Faculty either by on-site visits, telephone contacts, or by email

(if permitted by agency policies).

4. The site supervisor will complete two written evaluations of the student’s performance, one

at the middle and one at the end of the semester. The faculty supervisor will provide the

approved evaluation forms. The site supervisor will discuss the evaluations with the student

and provide a copy of the evaluations to the student and the faculty supervisor.

5. The site supervisor is responsible for informing the faculty supervisor of any problems that

may be interfering with the student’s progress during the semester.

6. The site supervisor is required to review and sign the weekly Clinical Experiences Log.

Gannon University Clinical Mental Health Counseling Program Responsibilities:

1. The Clinical Mental Health Counseling Program will make every effort to provide

opportunities for students to counsel clients who represent the racial, ethnic, and

demographic diversity of their community.

2. The Clinical Mental Health Counseling Faculty Supervisor will provide a minimum of 1.5

hours of group supervision weekly. The faculty supervisor may also provide 1 hour of

individual or triadic supervision in order to further meet the developmental needs of

Practicum students. When necessary, this may occur several times throughout the semester.

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The faculty supervisor will review and verify the two written evaluations of the student’s

performance, one at the middle and one at the end of the semester.

3. The Clinical Mental Health Counseling Program Faculty initiate four contacts with the Site

Supervisor either by on-site visits, telephone contacts, or by email.

4. The program will participate with the practicum site in the screening and selection of

practicum students. The Gannon University Clinical Mental Health Counseling Program

will respect a request by a site to remove a practicum student from that site if the student is

not capable of functioning at the required level of proficiency or if for any reason the student

is found to be unsuitable for assignment in that site.

5. The program will share appropriate requested information regarding the student’s

background experience and educational accomplishments and needs.

6. The program will enforce rules and regulations governing the student that is mutually agreed

upon by the Gannon University Clinical Mental Health Counseling Program and the

practicum site. Students will be expected to abide by the policies and procedures at the

practicum site and to respect the confidential nature of the case records at the site.

7. The program will retain copies of Background Clearances and evidence of Professional

Liability Insurance provided by the student.

8. The program will assume responsibility for the assignment of a final grade for the clinical

experience.

Student Responsibilities:

1. The student will make every effort to counsel clients who represent the racial, ethnic, and

demographic diversity of community affiliated with the practicum site.

2. The student will act in accordance with the highest ethical standards of the counseling

professional as defined by ACA Code of Ethics.

3. The student will document all hours spent at the site and notify the faculty supervisor if the

student should project any difficulty in meeting the required 100 hours before the end of the

semester. The student may accrue hours no earlier than one week prior to the first day of the

semester and no later than two weeks after the last week of classes.

4. Students are required to audio record or obtain live observation by the site supervisor or

faculty supervisor for at least two counseling sessions per semester. Cell phones and

computers are not acceptable for recordings.

5. The student agrees to notify the faculty supervisor if the student has any difficulty

performing counseling functions or establishing satisfactory relationships with personnel at

the site.

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All persons signing below acknowledge that they have read the Clinical Experiences Handbook

and are in agreement with the conditions set forth in this contract. Any modifications to this

contract will be negotiated between the faculty supervisor and the practicum site.

Name of Practicum Site Practicum Site Representative and Title

Site Supervisor Date

Faculty Supervisor Date

Student Date

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INTERNSHIP - Clinical Experience Contract

Clinical Mental Health Counseling Program - Department of Psychology and Counseling

This contract between the MS-Clinical Mental Health Counseling Program in the Department of

Psychology and Counseling at Gannon University and

_____________________________________

clarifies the joint and separate responsibilities of each facility and for the internship student

during the

_____ semester 20__ for the following student:

________________________________________

and the following on site supervisor: _________________________________________.

Internship Site Responsibilities:

1. The internship site is an equal opportunity employer.

2. The internship site must provide a site supervisor who will provide one hour of individual or

triadic supervision per week. The supervisor’s credentials must include a minimum of a

Master’s degree in counseling or a related field and at least two years of professional

experience in the field.

3. It is expected that students will be exposed to a variety of activities on-site, including direct

client contact, supervision, consultation, staff meetings, in-service trainings, and assessment.

Clients’ presenting problems should be mental/emotional in nature to allow students to

develop and refine their counseling skills. At least 240 hours of the required 600 hours must

be in direct service. Direct service includes individual, group, and family therapy,

assessment and intake services, psycho-educational services, and consultation provided to

others.

4. Students are required to audio record or obtain live observation by the site supervisor or

faculty supervisor of at least two counseling sessions per semester. Recordings used for

instructional purposes should have all identifying information removed and be erased in

their entirety following supervisory sessions.

5. The site will provide sufficient office space, privacy for counseling sessions, use of

necessary equipment, office supplies, etc. for an effective internship experience.

6. The site is responsible for informing the faculty supervisor of changes in agency policies,

procedures, and personnel that might affect the internship experience.

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7. Supervisees are required to work at the same location as their site supervisors or a

designated site supervisor, at all times. Supervisees are not allowed to conduct mobile

therapy, home visits, or transport clients. They should work within the regularly scheduled

hours that a designated site supervisor is on-site and readily accessible. Exceptions to this

policy require the expressed approval of the program Clinical Experiences Coordinator.

8. The site agrees not to terminate the clinical experience placement prior to completion of the

university semester without a meeting between the student, the faculty supervisor, the site

supervisor, and other interested parties.

Site Supervisor Responsibilities:

1. The site supervisor will make every effort to provide opportunities to students to counsel

clients who represent the racial, ethnic, and demographic diversity of their community.

2. The site supervisor will be responsible for providing one hour of individual or triadic

supervision per week.

3. The site supervisor will allow for one site visit and four contacts with the Clinical Mental

Health Counseling Program Faculty either by on-site visits, telephone contacts, or by email

(if permitted by agency policies).

4. The site supervisor will complete two written evaluations of the student’s performance, one

at the middle and one at the end of the semester. The faculty supervisor will provide the

approved evaluation forms. The site supervisor will discuss the evaluations with the student

and will provide a copy of evaluations to the student and the faculty supervisor.

5. The site supervisor is responsible for informing the faculty supervisor of any problems that

may be interfering with the student’s progress during the semester.

6. The site supervisor is required to review and sign the weekly Clinical Experiences Log.

Gannon University Clinical Mental Health Counseling Program Responsibilities:

1. The Clinical Mental Health Counseling Program will make every effort to provide

opportunities to students to counsel clients who represent the racial, ethnic, and

demographic diversity of their community.

2. The Clinical Mental Health Counseling Program Faculty will provide a minimum of 1.5

hours of group supervision for internship students.

3. The Clinical Mental Health Counseling Program Faculty will initiate four contacts with the

Site Supervisor either by on-site visits, telephone contacts, or by email (if permitted by

agency policies).

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4. The program will participate with the internship site in the screening and selection of

internship students. The Gannon University Clinical Mental Health Counseling Program

will respect a request by a site to remove an internship student from that site if the student is

not capable of functioning at the required level of proficiency or if for any reason the student

is found to be unsuitable for assignment in that site.

5. The program will share appropriate requested information regarding the student’s

background experience and educational accomplishments and needs.

6. The program will enforce rules and regulations governing the student that is mutually agreed

upon by the Gannon University Clinical Mental Health Counseling Program and the

internship site. Students will be expected to abide by the policies and procedures at the

internship site and to respect the confidential nature of the case records at the site.

7. The program will retain copies of Background Clearances and evidence of Professional

Liability Insurance provided by the student.

8. The program will assume responsibility for the assignment of a final grade for the clinical

experience.

Student Responsibilities:

1. The student will make every effort to counsel clients who represent the racial, ethnic, and

demographic diversity of community affiliated with the practicum site.

2. The student will act in accordance with the highest ethical standards of the counseling

professional as defined by the ACA Code of Ethics.

3. The student will document all hours spent at the site and notify the Clinical Experience

Coordinator if the student should project any difficulty in meeting the required 600 hours

before the end of the semester. The student may accrue hours no earlier than one week prior

to the first day of the semester and no later than two weeks after the last week of classes.

4. Students are required to audio record or obtain live observation by the site supervisor or

faculty supervisor of at least two counseling sessions per semester. Cell phones and

computers are not acceptable for recordings.

5. The student agrees to notify the faculty supervisor if the student has any difficulty

performing counseling functions or establishing satisfactory relationships with personnel at

the site.

All persons signing below acknowledge that they have read the Clinical Experiences Handbook

and are in agreement with the conditions set forth in this contract. Any modifications to this

contract will be negotiated between the faculty supervisor and the internship site.

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Name of Internship Site Date

Internship Site Representative and Title Date

Site Supervisor Date

Faculty Supervisor Date

Student Date

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SUPERVISOR DATA

Gannon University

Clinical Mental Health Counseling Program

Name of Supervisor

Name of Agency ____

Business Address

Zip

Email Address

Business Telephone Number ( )

Current Job Title

LICENSURE INFORMATION

Type of License State & Department License #/ID &

Issuing License Expiration Date

CERTIFICATION INFORMATION

Type of Certification State & Department or Certification #/ID &

Organization Issuing Expiration Date

Certificate

EDUCATIONAL/ACADEMIC INFORMATION

Highest Degree Earned Major/Program of Study College/University

Supervision Training (Please Check All That Apply):

Graduate Coursework Professional Workshops Other ____________________

Years of Counseling Experience

*Please attach Professional Disclosure Statement and/or Resume/CV

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Counseling Practicum / Internship Completion Form

The Completion Form is to be signed by the Site Supervisor and returned to the Faculty

Supervisor for verification upon completion of each clinical experience: practicum and

internship. This form then will be placed in the student’s permanent file.

--------------------------------------------------------------------------------------------------------

PART A: TO BE COMPLETED BY THE STUDENT

Name__________________________________

Address____________________________________________ Zip ______________

Home Phone ( ) ____________________ Work Phone ( ) __________________

Course Completed (check): ( ) GCOU 650 Supervised Practicum ( ) GCOU 651 Supervised Internship

---------------------------------------------------------------------------------------------------------

PART B: TO BE COMPLETED BY THE SITE SUPERVISOR

This is to certify that as of _____________________ (enter date) the above named student has

completed __________________ total hours experience under my supervision at:

Site Name _____________________________________________________________

Address___________________________________________________ Zip__________

Site Phone ( ) _____________________ E-mail: _______________________

Site Supervisor Signature ______________________________________

-----------------------------------------------------------------------------------------------------------

PART C: TO BE COMPLETED BY THE FACULTY SUPERVISOR

1. Supervision during this experience has been provided as follows:

______ Individual supervision hours provided by Site Supervisor

______ Group faculty supervision hours provided by Gannon Faculty

______ Individual supervision hours provided by Gannon Faculty

2. Client contact hours verified (check appropriate course being completed)

( ) Internship -600/240 ( ) Practicum 100/40

______ Direct contact hours with clientele served on site

______ Indirect contact hours in counseling related experiences on site

The accuracy of the reported information has been verified through student contact and an

examination of the student’s experience log.

Faculty Supervisor ________________________________________ Date ____________

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COUNSELING SKILLS SCALE (CSS)- Practicum

University Name______________________ Student Name______________________

Review by Audio____Video____Transcript____ Reviewer Name______________________

Reviewed after: Strategies & Techs. ____ Practicum____

This survey assesses the quality of student performance of counseling skills. It divides nineteen specific “micro

skills” into six groupings (in caps following roman numerals). Please first rate the student’s micro skills as –2, -

1, 0, +1, or +2 according to the scale below. Then summarize each grouping of skills by adding and averaging

its individual micro skills scores. Place that average in the blank following the grouping heading.

NOTE: If a skill is not performed but does not seem necessary, then assign it an “NN” and average only those

skills performed into mean grouping scores. If a skill is not performed but should have been, then give it a score

of –2 or –1 and average it with the rest of the skills performed under that super-heading.

+2 Highly developed: helpful, well-timed, and consistently well-performed

+1 Well developed: helpful and well-timed when performed, but not consistently smooth

0 Developing skills: somewhat helpful but too many missed opportunities

-1 Continue practice: not helpful or well-timed, or no skill existent when it should be

-2 Major adjustment needed: not at all helpful or well-timed

NN Not performed, but not necessary; (an) other skill(s) within this “grouping” used to

effectively meet this grouping’s goals

I. SHOWS INTEREST AND APPRECIATION Group Score _______

1. Body Language and Appearance – Maintains open, relaxed, confident posture

with appropriate eye contact. Leans forward when talking, leans back when client talks

on target. Uses head nods and body gestures to encourage client talk. Maintains

professional dress. -2 -1 0 +1 +2

2. Minimal Encouragers -- Repeats key words and phrases. Uses prompts

(uh huh, okay, right, yes) to let client know s/he is heard. Uses silence helpfully. -2 -1 0 +1 +2

3. Vocal Tone – Uses vocal tone that matches the sense of the session and

session goals. Vocal tone communicates caring and connection with the client. -2 -1 0 +1 +2

4. Evoking and Punctuating Client Strengths -- Includes questions and

reflections related to assets and competencies; positively reframes client experiences. -2 -1 0 +1 +2 NN

II. ENCOURAGES EXPLORATION Group Score _____ 5. Questioning -- Asks open-ended questions that encourage the client to

continue talking and to provide information. Uses when needed and when theoretically

consistent. Uses closed questions judiciously. Does not overuse questions. -2 -1 0 +1 +2 NN

6. Requesting Concrete and Specific Examples -- Asks for concrete and specific instances when clients provide vague generalities. ("Give me an

example of how you might feel or behave when facing __________.") -2 -1 0 +1 +2 NN

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+2 Highly developed: helpful, well-timed, and consistently well-performed

+1 Well developed: helpful and well-timed when performed, but not consistently smooth 0 Developing skills: somewhat helpful but too many missed opportunities

-1 Continue practice: not helpful or well-timed, or no skill existent when it should be

-2 Major adjustment needed: not at all helpful or well-timed NN Not performed, but not necessary; (an) other skill(s) within this “grouping” used to effectively meet this grouping’s goals

7. Paraphrasing (reflection of content) -- Engages in brief,

accurate, and clear rephrasing of what the client has expressed. -2 -1 0 +1 +2 NN

8. Summarizing -- Makes statements at key moments in the session that

capture the overall sense of what the client has been expressing. -2 -1 0 +1 +2 NN

III. DEEPENS THE SESSION Group Score _____ 9. Reflecting Feeling -- States succinctly the feeling and the content of the

problem faced by the client ("You feel ______ when ______.") -2 -1 0 +1 +2 NN

10. Using Immediacy -- Recognizes here-and-now feelings, expressed verbally

or nonverbally, of the client or the counselor. Can be related to the counselor-client

relationship. ("As we talk about _____ problem, I sense you are feeling _____ about

me. In turn, I'm feeling _____ about how you are viewing the problem right now.") -2 -1 0 +1 +2 NN

11. Observing Themes and Patterns -- Identifies more overarching patterns

of acting, thinking, or behaving in problem situations (“In ______ situations,

you regularly do _____ [or think______ or feel _____."]) -2 -1 0 +1 +2 NN

12. Challenging/Pointing out Discrepancies -- Expresses observations

of discrepancies. ("You expect yourself to do_____ when facing the problem of _____,

but you do ______ instead. When this happens you feel _____ about yourself.") -2 -1 0 +1 +2 NN

13. Reflecting Meaning and Values – Reflects the unexpressed meaning

or belief/value system that is behind the words the client is saying. (“You feel

strongly about making choices based on _______ belief.”) -2 -1 0 +1 +2 NN

IV. ENCOURAGES CHANGE Group Score _______

14. Determining Goals and Desired Outcomes -- Collaboratively determines outcomes toward which the counseling process will aim. Helps

client set goals. -2 -1 0 +1 +2 NN

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+2 Highly developed: helpful, well-timed, and consistently well-performed

+1 Well developed: helpful and well-timed when performed, but not consistently smooth 0 Developing skills: somewhat helpful but too many missed opportunities

-1 Continue practice: not helpful or well-timed, or no skill existent when it should be

-2 Major adjustment needed: not at all helpful or well-timed NN Not performed, but not necessary; (an)other skill(s) within this“grouping”used to effectively meet this grouping’s goals

15. Using Strategies for Creating Change – Uses

theoretically-consistent and intentional intervention strategies to help

client move forward toward treatment goals [such as setting up

reinforcement systems, using guided imagery, asking the miracle

question, directives, self-disclosure, interpretation, advice, opinion, information

instruction]. -2 -1 0 +1 +2 NN

16. Considering Alternatives and their Consequences -- Helps the client review possible solutions and the value of each over the long term.

(“One option would be ________, and that would mean________.

Another option would be….”) -2 -1 0 +1 +2 NN

17. Planning Action and Anticipating Possible Obstacles -- Reaches agreement about actions to take between sessions, who is responsible for

them, and when they will be done. Helps client to list what obstacles might interfere

and decide how to handle them. (“So, you will do __________by ______

date. What could prevent you from accomplishing your plan?”) -2 -1 0 +1 +2 NN

V. DEVELOPS THERAPEUTIC RELATIONSHIP Score _______

18. Consistently engages in caring manner with client, particularly by

demonstrating such core conditions as genuineness and authenticity,

warmth and acceptance, respect and positive regard, and empathy. -2 -1 0 +1 +2

VI. MANAGES THE SESSION Score _______ 19. Opens session smoothly and warmly greets client. Begins work on counseling

issues in a timely way. Structures session, directing client naturally through

opening, exploration, deeper understanding, creating change, and closing; focuses

client on essence of issues at a level deep enough to promote positive movement.

Smoothly and warmly ends the session, in a timely way, planning for future sessions

or for termination. -2 -1 0 +1 +2

TOTAL CSS SCORE (add grouping averages): _______________

Evaluator Comments:

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@Karen Eriksen. Permission to copy after participating in rater training and contingent on sending results back to Karen Eriksen

[email protected]

Areas for Improvement:

Assets and Strengths:

General Comments:

Substantial agreement with evaluation [By Student]: _______ Yes _______ No

Comments [By Student]:

Signatures:

Site Supervisor: __________________________________ Date: __________________

Student: __________________________________________ Date: __________________

Faculty Supervisor: _______________________________ Date: __________________

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INTERNSHIP EVALUATION (Do not use for Practicum)

Intern Name: ______________________ Site Supervisor Name: ________________________

Check one: _____ Midterm Evaluation _____ Final Evaluation Date: _______________

COUNSELOR SKILL AND PERSONAL DEVELOPMENT

RATING FORM (CSPD-RF) (Wilbur, 1991, modified by Torres Rivera, 1995)

Directions: Using the following 20 items, rate the counselor’s personal and/or skill development (depending on

the personal development or skill focus of the item) based on your observation of his/her counseling session

with the client. Each of the 20 items is to be rated, using the following Likert-type scale, from 1 (the lowest

rating) to 6 (the highest rating). Circle a number, for each of the 20 items, that best indicates your observation

and rating of the counselor’s personal and/or skill development in the session with the client.

Please respond to each question according to the following scheme:

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

******************************************************************************

1. The counselor’s observed ability to communicate directly and honestly in her/his interaction with the client.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

2. The counselor’s observed use of clarification skills in responding to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

3. The counselor’s observed awareness of his/her own emotional states while interacting and communicating

with the clients.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

4. The counselor’s observed personal congruence between his/her own verbal and nonverbal behaviors in the

session with the client.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

5. The counselor’s observed emotional sensitivity (empathy, not sympathy) toward the client’s statements of

feelings, problems issues, conflicts, life situations, etc.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

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6. The counselor’s observed use of paraphrasing and summarization skills in responding to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

7. The counselor’s observed use of feedback skills in responding to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

8. The counselor’s observed awareness of his/her own personal strengths and weakness while interacting and

communicating with the client.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

9. The counselor’s observed use of attending and observational skills while responding to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

10. The counselor’s observed use of giving/providing directives in his/her responses to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

11. The counselor’s observed use of confrontation skills in responding to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

12. The counselor’s observed tolerance for differences between his/her perspectives (be they cultural, socio-

economic, socio-political, gender, sexual preference, race, age, ethnicity, etc.) and differing perspectives

observed in or expressed by the client.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

13. The counselor’s observed use of advice/information and educational/instructional skills in his/her responses

to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

14. The counselor’s observed awareness of his/her sexist, racist, ageist, and etc. beliefs, feelings, and behaviors

while interacting and communicating with the client. 1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

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15. The counselor’s observed use of interpretation skills in his/her responses to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

16. The counselor's observed awareness of his/her own interpersonal influence on the client while interacting

and communicating with the client.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

17. The counselor’s use of reflection of meaning and reflection of feelings skills while responding to client’s

statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

18. The counselor’s observed awareness of his/her own general beliefs while responding to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

19. The counselor’s observed awareness of his/her own personal and familial development in response to

client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

20. The counselor’s observed use of self-disclosure skills in responding to client’s statements.

1

Unacceptable

2

Very Poor

3

Poor

4

Good

5

Very Good

6

Outstanding

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Limitations and Weaknesses:

Assets and Strengths:

General Comments:

Substantial agreement with evaluation [By Intern]: _______ Yes _______ No

Comments [By Intern]:

Signatures:

Site Supervisor: __________________________________ Date: __________________

Intern: __________________________________________ Date: __________________

Faculty Supervisor: _______________________________ Date: __________________

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SUPERVISOR FEEDBACK FORM

Supervisee Name _____________________________________

Supervision semester ___________________ Site ______________________________________

Supervisor Name _____________________________________ Date ________________

Purpose: To provide the supervisor with feedback on job performance in relation to the supervisee

experience and to permit the student to offer feedback to the supervisor in a written form that is

based on a set of clearly and previously-established criteria

Performance Level Rating Scale: Based on current assessment and progress of supervision and expectations

of supervisee:

3 – much more of this is needed

2 – it would be desirable to have somewhat more

1 – it would be desirable to have a little more

0 – this area is satisfactory

Directions: Utilizing the Rating Scale above, place the appropriate number on the line provided at the end of

each item.

Evaluation Items

Supervisor is able to:

1. Be flexible and responsive to your changing needs __

2. Establish an atmosphere of acceptance and psychological safety __

3. Call attention to errors in a tactful manner __

4. Recognize and accommodate to your level of experience and style of learning __

5. Refrain from indiscriminate use of praise __

6. Provide opportunities for your to question, challenge or doubt __

7. Encourage you to explore the implications of your interventions __

8. Encourage you to formulate your understanding of the case material __

9. Make specific suggestions when you need them __

10. Not foster undue dependence on your part __

11. When asked, present a clear, theoretical rationale for suggestions __

12. Clearly inform you of legal issues __

13. Clearly inform you of ethical issues __

14. Be sensitive to the requirements placed on you by your agency __

15. Admit errors and/or limitations without undue defensiveness __

16. Be concrete and specific in comments __

17. Facilitate your understanding of countertransference reactions to your clients __

18. Seek consultation when it is needed __

19. Summarize and/or highlight major points of supervisory session __

20. Be reached in case of emergencies __

21. Help you formulate the dynamics of the client __

22. Listen sensitively to you __

23. Help clarify and define the nature of problem(s) you are having in your work __

24. Be clear about the limits of the supervisory relationship __

25. Deal explicitly with the formal evaluation process __

26. Through role-playing or other suitable techniques, to help you more effectively __

27. Be straightforward with you regarding areas in which you need improvement __

28. Be clear with you about the differences between supervision and psychotherapy __

29. Maintain an appropriate focus in your sessions __

30. “Be there” to meet your needs and not impose his/her issues on you __

31. Be open to discussing any difficulties between the two of you

which are hindering your learning __

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32. Clearly define the nature, structure, expectations __

33. Make decisions and take responsibility when appropriate __

34. Make you feel s/he genuinely want to help you learn __

35. Be a good role model for you __

36. Provide you with general knowledge about professional psychology __

37. Be sensitive and adaptive to the stresses you are experiencing as a student __

Summarize the supervisor’s strengths and weaknesses as you currently view them and make suggestions for

ways in which your supervisor could further facilitate your learning.

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

This form has been adapted from the Hall-Marley (2001) Supervisor Feedback form as an instrument to provide

feedback to supervisors on the trainee’s experience of supervision. The form consists of sections including

atmosphere for learning, supervision style, supervision conduct, and supervision impact.

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CLIENT RECORDING CONSENT FORM

Clinical Mental Health Counseling Program

Department of Psychology and Counseling

Gannon University

GCOU 650 Supervised Practicum

GCOU 651 Supervised Internship

I, _________________________ consent to the audio recording of my individual/group /family counseling

session(s) with _________________________, a student counselor-in-training from Gannon University

Clinical Mental Health Counseling Program. I understand that the recorded session(s) may be reviewed

by the student counselor-in-training, his/her supervisors, and by students in the Supervised Practicum or

Internship course as an educational and training tool. I understand that confidentiality will be safely

guarded at all times. I understand that only first names will be used to ensure confidentiality. I

understand that all recordings will be destroyed at the completion of the ______ fall ______ spring

semester 20______ . Should I have any further questions I may contact the student counselor trainee’s

site supervisor, ________________________, at (814) ________________ or his/her university supervisor,

________________________, at (814) ________________.

____________________________________ ________________

Signature of Client Date

____________________________________ ________________

Signature of Parent/Guardian (if client is under 14yrs) Date

____________________________________ ________________

Signature of Student Counselor-in-Training Date

____________________________________ ________________

Signature of Site Supervisor Date

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The Counselor Preparation Comprehensive Examination (CPCE)

The Gannon University Clinical Mental Health Counseling Program uses the Counselor Preparation

Comprehensive Examination (CPCE) to evaluate students’ core knowledge of counselor competency areas.

The CPCE is maintained by the Center for Credentialing and Education (CCE), an affiliate of the National

Board for Certified Counselors (NBCC). The CPCE is a computer-based, off-campus testing experience similar

to other standardized test like the SATs or GREs. Pearson VUE is the current administrator. CPCE is available

as follows:

Summer Semester CPCE to be complete by the last business day of July (Second Summer)

The cost for students is $150.

Dr. McCurdy is the coordinator for the CPCE. Students should plan on taking the CPCE after completing the

Foundations courses, the Counseling Core I and Core II courses. The Advanced courses can be taken

concurrently or after a student completes the CPCE. If possible, it is advisable to take the CPCE the semester

before GCOU 650 Practicum. Students must enroll in GCOU 691 Counselor Preparation, a 0 credit course to

take the CPCE. GCOU 691 should be taken concurrently with GCOU 690 Seminar in Counseling. All of the

following courses should be completed, or taken concurrently with GCOU 691, in order to take the CPCE:

Foundations of Professional Counseling

Sequence

GCOU 605 Group Dynamics

GCOU 608 Human Development Over the Life Span

GCOU 627 Professional Counseling

GCOU 648 Counseling Strategies & Techniques

Counseling Core I Sequence

GCOU 603 Research Methodology

GCOU 610 Counseling & Personality Theories

GCOU 625 Multi-Cultural Issues in Counseling

GCOU 631 Diagnosis & Treatment Planning

Counseling Core II Sequence

GCOU 612 Family Systems

GCOU 613 Appraisal in Counseling

GCOU 622 Career Development & Counseling

GCOU 642 Child and Adolescent Counseling

GCOU 690 Seminar in Counseling

GCOU 691 Counselor Preparation

The National Counselor Examination (NCE)

The Gannon University Clinical Mental Health Counseling Program participates in a special program through

NBCC to allow our students to take the NCE, prior to graduation, at Gannon; the GSA-NCC Program. Students

who wish to become Nationally Certified Counselors and/or Licensed Professional Counselors in Pennsylvania

must take and pass the NCE. As a participant in the GSA-NCC Program, Gannon Counseling Students can take

the NCE one semester before graduation or one semester after graduation from Gannon. Students must

communicate their intent to take the exam in advance, usually during GCOU Supervised Practicum. GSA-NCC

Applications to take the NCE exam are available as follows:

April NCE Exam Date Application available in November / Due Beginning of December

October NCE Exam Date Application available in May / Due Beginning of July

Dr. McCurdy is the GSA-NCC Coordinator. All applications and related material are available at his office

during these designated timeframes. There is a cost for completing the GSA-NCE Application and taking the

NCE Exam. It is currently $310.00 payable with the application. If a student chooses not to take the NCE as

part of the GSA-NCC Program, he/she will be required to contact the NBCC on their own and take the NCE as

a “Professional” which has different requirements, application guidelines, a higher application fee, and may

require travel to Pittsburgh or another testing site arranged by NBCC. We strongly advise students to

participate in the GSA-NCC Program and take the NCE prior to graduation. If a student does not pass, he/she is

eligible to retake the exam.

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Gannon University

Clinical Mental Health Counseling Program

Psychology and Counseling Department

Policy and Guidelines for Social Networking/Electronic Devices

Policy:

The Clinical Mental Health Counseling Program expects adherence to the following guidelines and practices

which are intended to protect the integrity of the students, faculty, clinical site supervisors, Gannon University,

and the public. This policy provides specific guidelines and protocols for Clinical Mental Health Counseling

students and faculty in the use and application of electronic forms of communication not limited to: Face Book,

Twitter, My Space, You Tube, Blogs, Live Journal, email, communication through Gannon’s learning

management system (BLACKBOARD), text, and other future forms.

Clinical Mental Health Counseling students are expected to accept the responsibilities of social media

participation and the use of electronic devices.

General Guidelines:

Current students must:

Demonstrate respect for the Gannon University Clinical Mental Health Counseling Program, faculty,

staff, and students

Refrain from electronic communication while in class or at clinical experience sites

Demonstrate respect when references are made which reflect on Gannon University Clinical Mental

Health Counseling Program, faculty, staff, and students

Be aware that actions posted in images or comments can reflect on your professional image and status as

an emerging professional counselor

Prevent and report cyber bullying, harassment, discrimination or illegal activity to the Program Director

that involve Gannon University Clinical Mental Health Counseling Program, faculty, staff, and students

Prevent and report any circumstances of a threat or slander of another individual to the Program

Director.

Additional Guidelines for Practicum and Internship:

Current practicum and internship students must:

Not refer to clients, families, staff, colleagues, or their Clinical Experience sites in any way

Demonstrate professional communications that acknowledge:

o Understanding that email and text messages are not secure methods of communication and

should not be used for transmission of confidential information either in the body of the email or

as an attachment

o Understanding that the use of disclaimers does not release the responsibility of the sender and/or

receiver of the information from ethical/legal mandates provided by HIPAA, FERPA, and other

regulations protecting privacy and confidentiality

o Understanding that client contacts can become court records: emails, text messages, IM’s,

Twitter, etc.

o Conformity to work schedules so as not to create the illusion of expanded availability for clients

(Maintain appropriate time boundaries for email, text messages, Face Book, Twitter, and other

electronic forms of communication)

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Additional Guidelines for Face Book:

Demonstrate professional communications that reflect:

o Images congruent with ethical standards of a professional counselor-in-training such as

counselor integrity, past and current client confidentiality, boundaries

o Understanding that information can be viewed by clients, potential employers, peers, colleagues,

faculty, and supervisors.

o Understanding that information posted does not ever “go away”

o Understanding that information can be copied, printed, and reposted to multiple sites, searched

using search engines like Bing, Google, and Yahoo